Provider Demographics
NPI:1710663885
Name:CENTURY EXPRESS CARE LLC
Entity Type:Organization
Organization Name:CENTURY EXPRESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISACK
Authorized Official - Middle Name:BILLE
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-790-9202
Mailing Address - Street 1:1830 40TH AVE S APT 117
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7923
Mailing Address - Country:US
Mailing Address - Phone:218-790-9202
Mailing Address - Fax:
Practice Address - Street 1:1830 40TH AVE S APT 117
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-7923
Practice Address - Country:US
Practice Address - Phone:218-790-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health